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Pediatrics > ID > Flashcards

ID Flashcards

0
Q

Other manifestations of parvovirus

A

Arthritis
Aplastic crisis
Fetal hydrops (2-6% risk of fetal demise)
Papulopurpuric glove and socks syndrome = contagious!

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1
Q

Attack rate of parvovirus

A

50% household contacts

20-30% school exposure

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2
Q

HHV 6 manifestations

A 
Fever followed by rash
Occipital adenopathy
GI symptoms
Bulging fontanelle
Febrile seizures (15%
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3
Q

Risk factors for peripartum transmission of HIV

A

Advanced maternal disease
Prolonged ROM
Obstetric complications
First-born twin

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4
Q

Diagnosis of HIV in infants

A

PCR

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5
Q

HIV prophylaxis

A

Oral zidovudine for mother in 2nd trimester
IV zidovudine during delivery
Oral zidovudine for infant for 6 weeks

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6
Q

HIV and c-section

A

C/S decreases risk of transmission but effect for mothers with low viral load uncertain

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7
Q

PCP prophylaxis in HIV

A

Bactrim
Start at 4 to 6 weeks for all HIV exposed infants
Children 1 to 5 years if CD4 < 500
Children > 5 years if CD4 < 200

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8
Q

Vaccination in HIV

A

MMR - unless < 15% CD4; 2nd dose after 4 weeks

Varicella - normal CD4 count

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9
Q

HIV prophylaxis (other)

A

TB if PPD +

Varicella and measles Ig if exposed

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10
Q

Histoplasma epidemiology

A

Ohio and Mississippi River valleys; bat/bird droppings; caves

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11
Q

Histoplasma findings

A

95% asymptomatic
Pulmonary - mediastinal mass
Severe disease - erythema nodosum, HSM
Disseminated disease in immunosuppresed

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12
Q

Histoplasma infection in infants

A

Fever, HSM, lymphadenopathy, pancytopenia

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13
Q

Histoplasma treatment

A

Amphotericin B

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14
Q

Coccidioides epidemiology

A

Southwest US

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15
Q

Coccidioides findings

A

60% asymptomatic
Pulmonary - flu-like illness to severe pneumonia, pleural effusions
Hypersensitivity reactions - erythema nodosum

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16
Q

High risk for disseminated coccidiosis

A

Infants, Filipinos, African Americans, Hispanics

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17
Q

Most common form of disseminated coccidiosis

A

Meningitis

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18
Q

Treatment of coccidiosis

A

Amphotericin B

Fluconazole for CNS infections

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19
Q

Cryptococcosis findings

A

Meningitis ONLY in immunocompromised hosts

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20
Q

Cryptococcosis epidemiology

A

Pigeon roosting sites

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21
Q

Cryptococcosis treatment

A

Amphotericin B and flucytosine

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22
Q

Risk factors for invasive aspergillosis

A

Corticosteroids
Neutropenia
Chemotherapy
Acute organ rejection

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23
Q

Complications of acute invasive pulmonary aspergillosis

A

Invasion of blood vessels, infarction, hematogenous spread

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24
Q

Cause of rhinocerebral disease in DKA

A

Mucormycoses

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25
Q

What is latent TB

A

+PPD with negative CXR and normal exam

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26
Q

TB meningitis findings

A 
Gradual onset (2-3 weeks)
Fever, listlessness, nuchal rigidity, CN palsies (III, VI, VII), seizures
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27
Q

TB screening

A

Yearly: HIV+, incarcerated adolescents
Immediate: contact, clinical or X-ray findings, immigrants

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28
Q

PPD is considered positive when…

A

> 15 mm if > 4 years old and no risk factors
10 mm if < 4 years old or risk factors (travel, contact with high risk adults)
5 mm if close contact, clinical or X-ray evidence, immunocompromised

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29
Q

What percentage of healthy children with TB have negative PPD

A

10%

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30
Q

Latent TB treatment

A

9 months on INH (12 if HIV positive)

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31
Q

TB medication side effects

A

INH - hepatitis, peripheral neuropathy
Rifampin - orange body fluids, flu-like reaction, hepatitis
Pyrazinamide - hyperuricemia, hepatotoxic
Streptomycin - vestibular and auditory toxicity, renal toxicity
Ethambutol - optic neuritis

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32
Q

Treatment of non-TB mycobacterium

A

Excision

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34
Q

Exclusion of pregnant woman from workplace with parvovirus

A

NOT recommended

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35
Q

RMSF etiologic agent

A

Rickettsia rickettsii

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36
Q

RMSF epidemiology

A

Southeastern and south central US

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37
Q

RMSF findings

A

vasculitis!
fever, headache, myalgias, MS changes
rash = maculopapular/petechial, begins on wrists and ankles

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38
Q

RMSF treatment

A

Doxycycline (regardless of age)

Start w/in 6 days –> low mortality

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39
Q

Ehrlichiosis etiologic agent

A

Monocytic - E. chafeensis

Granulocytic - Anaplasma phagocytophilia, Ehrlichia ewingii

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40
Q

Ehrlichiosis epidemiology

A

E. chafeensis - SE and south central US

Anaplasma - WI, MN, CN, NY

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41
Q

Ehrlichiosis findings

A

Similar to RMSF but rash is less common

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42
Q

Ehrlichiosis diagnosis

A

Intraleukocytic inclusions, serology

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43
Q

Ehrlichiosis treatment

A

Doxycycline (regardless of age)

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44
Q

Tularemia transmission

A

Most often = tick bite
Also - direct contact, aerosolization, ingestion
rabbits = reservoirs

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45
Q

Tularemia gram stain

A

small gram-negative coccobacillus

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46
Q

Tularemia epidemiology

A

AK, MO, TN, TX

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47
Q

Tularemia findings

A

Olceroglandular form = most common

Fever, regional lymphadenopathy, ulcer/papule at site of inoculation

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48
Q

Tularemia treatment

A

Streptomycin

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49
Q

Leptospirosis transmission

A

contaminated farm bonds and animal slaughterhouses

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50
Q

Leptospirosis findings

A

Most often subclinical
Anicteric (milder) - abrupt fever, HA, myalgia, subconjunctival suffusion
Icteric - Weil syndrome = liver and renal failure, myocarditis

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51
Q

Weil syndrome

A

severe leptospirosis

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52
Q

Leptospirosis treatment

A

severe disease - IV PCN

mild disease - amoxicillin, doxycycline

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53
Q

Lyme disease clinical manifestations

A 
Early localized (3d to 4 wks) - erythema migrans
Early disseminated (4 to 8 wks) - flu-like, aseptic meningitis, carditis
Late disease (2 mo to years) - arthritis
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54
Q

Most common form of neuroborreliosis

A

CN VII palsy

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55
Q

Rat bite fever etiologic agent

A

Streptobacillus moniliformis

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56
Q

Plague etiologic agent

A

Yersinia pestis (gram negative coccobacillus)

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57
Q

Plague epidemiology

A

Western US

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58
Q

Plague transmission

A

Fleas, rodents

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59
Q

Plague treatment

A

Streptomycin

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60
Q

P. falciparum findings

A

Potentially rapidly fatal course, hyperparasitemia (> 5%), cerebral malaria, severe anemia, multi-organ failure

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61
Q

P. vivax and P. ovale findings

A

Anemia, hypersplenism, relapse (latent hepatic stage)

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62
Q

Malaria diagnosis

A

Thin and thick smear

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63
Q

Malaria treatment

A

Severe disease - Quinidine

Chloroquine resistant - Atovaquone, Mefloquine

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64
Q

Malaria findings

A

Paroxysms of fever, chills, HA, nausea, vomiting, abdominal pain, pallor, jaundice

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65
Q

Babesiosis microbiology

A

Intraerythrocytic protozoa

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66
Q

Babesiosis transmission

A

Ticks (Ixodes scapularis - same as Lyme disease)

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67
Q

Babesiosis findings

A

Fever, malaise, HA, mild HSM, conjunctival injection

Symptoms more likely in asplenic, immunocompromised

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68
Q

Babesiosis treatment

A

Clindamycin + quinine

Atovaquone + azithromycin

69
Q

Most common helminthic infection

A

Ascariasis

70
Q

Loffler syndrome

A

ascariasis pneumonitis

71
Q

Ascariasis complications

A

abdominal pain, obstruction, pancreatitis, malnutrition

72
Q

Hookworm agent

A

Necator americanus

73
Q

Common cause of iron-deficiency anemia in the developing world

A

Hookworm (N. americanus)

74
Q

Hookworm findings

A

Pruritic dermatitis at entry site, anemia, hypoproteinemia, growth delay, neurodevelopmental delay

75
Q

Whipworm agent

A

Trichuris trichiuria

76
Q

Whipworm findings

A

Dysentery syndrome (diarrhea!), chronic colitis, rectal prolapse

77
Q

Pinworm agent

A

Enterobius vermicularis

78
Q

Pinworm transmission

A

Fecal-oral (childcare, school)

79
Q

Trichinella findings

A 
1-2 weeks after ingestion - gastroenteritis
Tissue phase (2-8 weeks after ingestion) - fever, bilateral peri-orbital edema, conjunctival/subungual hemorrhages
80
Q

Larva migrans agent

A

Toxocara canis, Toxocara cati

81
Q

Larva migrans transmission

A

Contaminated sandboxes, playgrounds

82
Q

Larva migrans diagnosis

A

Hypereosinophilia, hypergammaglobulinemia, elevated isohemagglutinin to A/B blood groups

83
Q

Tapeworm agent

A

Pork tapeworm - Taenia solium

Larvae - Cysticercus cellulosae

84
Q

Definitive host for tapeworm

A

Human

85
Q

Tapeworm epidemiology

A

Most cases imported from Latin America or Asia

86
Q

Indication for Varicella Ig

A

Neonates whose mother develop infection 5d before or 2d after delivery

87
Q

Measles rash

A

Begins on neck/head/face; spreads to trunk; becomes confluent

88
Q

Rubella findings

A

Adolescents
Pinpoint rash that begins on face and spreads to trunk
Post-auricular/post-occipital tender adenopathy

89
Q

C. trachomatis pneumonia

A

Develops in 10-20% of infants born to women with C. trachomatis
30-50% of infants have h/o conjunctivitis

90
Q

AOM bacteria resistance

A

S. pneumoniae - altered PCN binding protein

H. flu, M. catarrhalis - beta-lactamase

91
Q

Patients with mono and this disorder are at risk for ALF

A

XL lymphoproliferative disorder

92
Q

Pathophysiology of SSSS

A

Exfoliative toxin of S. aureus

93
Q

Most likely location to recover organism responsible for SSSS

A

Nasopharynx

94
Q

Most likely location to recover organism for bullous impetigo

A

Skin lesion

95
Q

Treatment of SSSS vs. bullous impetigo

A

SSSS - systemic anti-staph abx

Bullous imeptigo - topical abx

96
Q

Poor prognostic factors in children with meningococcemia

A

Hypotension
Petechial lesions w/in 12 hours of presentation
WBC < 10 K
Absence of meningitis

97
Q

Most common infectious cause of E. nodosum

A

Streptococcal infection

98
Q

GAS

A

S. pyogenes

99
Q

Ecthyma gangrenosum agent

A

Pseudomonas (signifies pseudomonal sepsis in immunocompromised patient)

100
Q

Bullous impetigo lesions

A

Localized, Nikolsky sign absent

101
Q

Enteric organisms transmitted in childcare settings

A

Bacteria - Shigella, E. coli
Virus - Rota, HAV
Parasites - Giardia, crypto

102
Q

AOM agent least likely to remit spontaneously

A

S. pneumonia (15-20%)

103
Q

Most common cause of VP shunt infection

A

Coagulase negative staph

104
Q

Classic CXR findings of inhalation anthrax

A

Widened mediastinum (hemorrhagic mediastinal lymphadenitis)

105
Q

Salmonella transmission

A

Poultry, pork, eggs, dairy, turtles, iguanas

Childcare center transmission = uncommon

106
Q

Enteric fever agents

A

Salmonella typhi, Samonella paratyphi

107
Q

Enteric fever findigns

A

fever, abdominal pain, HSM, AMS, bradycardia, “rose spots”

108
Q

Indications for antibiotics in Salmonella infection

A

Gastro in pt at high risk for bacteremia/suppurative infections
Bacteremia/Meningitis/Osteo
Enteric fever

109
Q

Salmonella treatment

A

Cefotaxime or ceftriaxone

110
Q

Most common complication of Shigella

A

Seizures (10-45% of hospitalized children)

111
Q

Indications for antibiotics in Shigella infection

A

Severe symptoms, dysentery, underlying conditions

112
Q

Shigella treatment

A

Cefotaxime or ceftriaxone

113
Q

Infections that require negative stool culture prior to return to school

A

Shigella

EHEC

114
Q

Most common cause of traveller’s diarrhea

A

Enterotoxigenic E. coli (ETEC)

115
Q

E. coli transmission

A

Ground beef, unpasteurized milk, raw vegetables, petting zoos

116
Q

Rate of HUS in patients with E. coli O157:H7

A

5-10%

117
Q

Campylobacter transmission

A

Poultry, meets, unpasteurized milk

Child care transmission = uncommon

118
Q

Complications of Campylobacter

A

GBS, reactive arthritis, Reiter syndrome

119
Q

Campylobacter treatment

A

Azithromycin

120
Q

Yersinia transmission

A

Uncooked pork, unpasteurized milk, untreated water

121
Q

Yersinia treatment

A

AG’s, cefotaxime, Bactrim

Treatment indicated in severe disease

122
Q

Most common cause of gastroenteritis

A

Rotavirus

123
Q

Transmission of caliciviruses

A

Shellfish, contaminated water (CCC and cruise ships)

124
Q

Most common protozoal infection in the US

A

Giardia

125
Q

Patients at highest risk for giardia

A

Hypogammaglobinemia, HIV

126
Q

Treatment for giardia

A

Metronidazole (recurs in 10-20%)

127
Q

Cryptosporidium transmission

A

Person-to-person, contaminated water, farm livestock

128
Q

Groups at risk for Cryptosporidium

A

Children 6-24 months, day care centers, farmers, T-cell immunodeficiencies

129
Q

Treatment of cryptopsoridium

A

Nitazoxanide

130
Q

Complications of Amebiasis infection

A

Intussusception, perforation, strictures, liver abscess

131
Q

Most common parasitic infections causing death

A
  1. Malaria, 2. Schistosomiasis, 3. Amebiasis
132
Q

Amebiasis treatment

A

Asymptomatic - iodoquinol

Symptomatic - metronidazole

133
Q

Organisms in preseptal cellulitis

A

Trauma - s. aureus, GAS

S. pneumo most likely if hematogenous or direct extension

134
Q

Most common causes of orbital cellulitis

A

Ethmoid sinusitis

135
Q

Most common organism in buccal cellulitis

A

S. pneumo

136
Q

Tenosynovitis-dermatitis syndrome

A

Adolescent with N. gonorrhoeae infection affecting smaller joints (wrist, hand, fingers)

137
Q

Seizures in meningitis

A

Occur in 30%

If occur w/in 3 days of diagnosis they are of NO prognostic significance

138
Q

Pneumococcal meningitis outcome

A

10-15% mortality, 30% long-term sequelae

139
Q

Meningococcal meningitis outcome

A

3-5% mortality, 10% long-term sequelae

140
Q

Meningitis prevention indication

A

Meningococcal - indicated for all close contacts (not HCW unless exposed to oral secretions)
Hib - households with patient < 4 yo and incompletely immunized

141
Q

Meningitis prevention medication

A

Rifampin

142
Q

Findings in HSV-1 encephalitis

A

Focal involvement of temporal lobes, hemorrhagic CSF

143
Q

Brain abscess organisms

A

Usually polymicrobial (Viridans strep, anaerobes, gram negatives)

144
Q

Brain abscess in neonates

A

Citrobacter species

145
Q

Brain abscess treatment

A

3rd generation cephalosporin and metronidazole

146
Q

Other manifestations of mycoplasma infection

A

Pharyngitis, EM, arthralgias, hemolysis

147
Q

Prophylaxis for diptheria exposure

A

IM pencillin G or oral erythromycin

148
Q

Granulomatosis infantisepticum

A

faint erythematous rash with small, pale nodules
associated with neonatal Listeria
maternal symptoms - GI and fever

149
Q

Treatment of measles exposure in unimmunized children

A

Immunoglobulin

150
Q

Causes of nongonococcal urethritis

A

C. trachomatis (23-35%), ureaplasma, mycoplasma, T. vaginalis

151
Q

Treatment of nongonoccoal urethritis

A

1 g of azithromycin (or 100 mg doxycycline BID x 7d)

152
Q

Rate of co-infection with Gonorrhea for patients with Chlamydia

A

15-50%

153
Q

Cell culture findings in Chlamydia

A

intracytoplasmic inclusions

154
Q

Gonorrhea treatment

A

Cefixime/Ceftriaxone AND treatment for Chlamydia (Azithromycin)

155
Q

PID etiology

A

polymicrobial

156
Q

Treatment of PID

A

A: Cefoxitin + Doxycycline
B: Clindamycin + Gentamicin

157
Q

Syphilis presentation

A

Primary - nontender inguinal adenopathy, painless chancre

Secondary - systemic sx, rash (palms/soles)

158
Q

False positive RPR

A

EBV, HBV, HSV, mycoplasma, mycobacteria, SLE, Hashimoto’s, pregnancy

159
Q

Chancroid etiology

A

Haemophilus ducreyi

160
Q

Chancroid findings

A

multiple purulent ulcers with tender inguinal adenopathy

161
Q

Chancroid treatment

A

azithromcyin

162
Q

HSV virus types

A

1 = oral, 2 = genital

163
Q

Lymphogranuloma venereum findings

A

one papule/vesicle or pustulre, tender lymphadenopathy

164
Q

LGV treatment

A

doxycycline

165
Q

Trichomonas vaginalis treatement

A

metronidazole

166
Q

Trichomonas vaginalis findings

A

bubbly, malodorous, yellow/gray/green discharge, strawberry cervix

167
Q

BV diagnosis

A

gray/white discharge, pH > 4.5, + whiff test, clue cells

168
Q

BV treatment

A

metronidazole

Pediatrics (14 decks)

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